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DOI: 10.1055/s-0042-1744115
Minimally Invasive Microsurgery for Cerebral Contusions
Microcirurgia minimamente invasiva para tratamento de contusões cerebraisAbstract
Introduction Traumatic brain injury (TBI) is among the main causes of death and neurological sequelae worldwide. Injuries are classified as diffuse (diffuse axonal injury and brain swelling) or focal (cerebral contusion [CCo], epidural hematoma, and acute subdural hematoma). Among all TBIs, CCos are the most frequent focal lesion, and treatment modalities are many. Hematoma evacuation using large craniotomies has been well described in the literature. The main goal of the present study is to discuss the advantages of minimally invasive approaches for the treatment of CCos, regarding operative time, blood loss, and postoperative tomographic results.
Methods An integrative literature review was conducted on the SciELO, LILACS, and PubMed databases. Seven case reports were included in the present study. Retrospective data collection was performed, analyzing gender, age, Glasgow coma scale score on hospital admission, surgical approach, and postoperative (tomographic) results.
Results The minimally invasive keyhole approach was used in seven patients with CCos. The supraorbital approach (n = 5) was performed for frontal lobe contusions, and the minipterional approach (n = 2) was performed for temporal lobe contusions. All cases had adequate hematoma evacuation, confirmed by postoperative computed tomography scans.
Conclusion The minimally invasive approaches were effective for hematoma evacuation, with adequate clinical and radiological postoperative results.
Resumo
Introdução O traumatismo cranioencefálico se encontra entre as principais causas de óbito e sequelas neurológicas na estatística mundial. As lesões são classificadas como difusas (lesão axonal difusa e edema cerebral traumático) ou focais (contusões cerebrais [CoC], hematoma epidural, e hematoma subdural agudo). Dentre todos os tipos de lesões cerebrais traumáticas, as contusões são a lesão focal mais comum, e são reservadas a elas múltiplas modalidades de tratamento. O principal objetivo desse estudo é discutir as vantagens dos acessos minimamente invasivos no tratamento de contusões cerebrais, especialmente no que concerne à duração do procedimento, perda sanguínea e resultados tomográficos pós-operatórios.
Métodos Uma revisão integrativa de literatura foi conduzida nas plataformas Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e PubMed. Sete relatos de caso foram incluídos neste estudo. A coleta retrospectiva de dados foi realizada com a análise das seguintes variáveis: gênero, idade, escala de coma de Glasgow à admissão, acesso cirúrgico utilizado e resultados tomográficos pós-operatórios.
Resultados O acesso cirúrgico minimamente invasivo foi utilizado em sete pacientes com CoC. O acesso supraorbital (n = 5) foi usado para tratar contusões frontais, enquanto o acesso minipterional (n = 2) foi usado para o tratamento de contusões temporais. Em todos os casos, foi obtida drenagem satisfatória do hematoma, confirmada por meio de tomografias pós-operatórias.
Conclusão Os acessos minimamente invasivos foram efetivos para evacuação dos hematomas intraparenquimatosos, com resultados clínicos e tomográficos favoráveis.
Keywords
brain contusion - minimally invasive surgery - brain trauma - traumatic brain injuries - microsurgery - trauma surgeryPalavras-chave
contusão cerebral - cirurgia minimamente invasiva - trauma cerebral - lesões cerebrais traumáticas - microcirurgia - cirurgia de traumaPublication History
Received: 10 June 2021
Accepted: 18 January 2022
Article published online:
10 October 2023
© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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